1 case of ultrasound imaging of duodenal nipple fluffy tube oma

Case male, 67 years old, to "medical examination found that the end of the bile tube occupied more than 2 months" as the main complaint admitted to the hospitalPatients in the past 4 months intermittent acid burning, before February no obvious cause of high fever, cold, body temperature up to 39.5 degrees C, no abdominal pain, bloating, jaundice, no nausea, vomiting and other discomfortultrasound examination: general expansion of the biliary tube in the liver, about 0.4 cm wide, biliary tube expansion, width of about 1.3 cm, end duodenum nipples visible 1.5 cm x 1.1 cm low echo group (Figure 1), boundary blur, with the form of duodenum creep changes, ultrasound imaging shows: arterial phase 23s lesions overall enhanced (Figure 2), after the lesions are enhanced The main pancreas tube did not expandUltrasounddiagnosis: low echo group at the end of the biliary tube, ultrasound imaging does not exclude duodenum nipple adenoma;Figure 1 2D sound image shows the end of the bile tube low echo group, the boundary blur (the arrow is the lesions)Figure 2CEUS Arterial biliary end of the low echo cluster overall high enhancement (arrow at the lesions)patients admitted to the hospital after the pancreas duodenal excision, surgery see: the end of the bile tube adjacent to the duodenum large nipples see the diameter of about 1 cm, pink soft, poor boundariesWhat can be seen under the mirror: the epithelial nipple growth of the duodenal gland, some cells moved up high columnPathological diagnosis: duodenum nipple bile tube end: fluffy tube adenoma, bureau stove high-level epithelial endomafigure 3: gland hyperplies are densely arranged, tubular or fluffydiscussion
duodenal adenoma is a rare small intestine benign tumor, the incidence is insufficient5% of the digestivetumor, the disease is hidden, the pathogenesis mechanism is not clear, to 50 to 70 years old more common, good hair in the duodenum section around the pot belly According to the pathology of the mirror it is divided into: (1) fluffy adenoma: fluff ypap, wide substrate, soft, easy to change; Early asymptomatic or mild, with the development of the disease, due to the size and shape of the lesions, there will be nausea, vomiting, abdominal pain, obstructive jaundice and other symptoms, can also be accompanied by high fever, cold Clinical manifestations lack specificity imaging examination is the main means to diagnose duodenal adenoma Low twelve-finger intestinal imaging (HD) is accurately located, but can not determine the structure of the lesions, can not observe the extracavity lesions In addition to indirect signs such as hepatic and external bile ducts or main pancreatic tube expansion, CT-enhanced lesions can be mildly or moderately enhanced, but the accuracy of detection of smaller lesions is low, and the tissue source for identifying nipple lesions is relatively difficult; Ultrasound can be real-time dynamic observation of lesions, this case found lesions with the creep of the duodenum and movement, and the morphological changes, can infer the source of lesions, while CEUS prompt lesions enhanced, which for the disease and stones, gallstones and other differential diagnosis provides an important imaging basis